Posted By Posting
Sep 30, 2008
jessicalynn
Brent 2 years old,
Birthweight 12 lbs 3.3 oz!
Very severe GERD,LPR,FTT
Severe esophagitis/scarring
Paraesophageal Hiatal Hernia,
Esophageal Dysmotility,
Food impaction,Aspiration
ALTE,Dysphagia,Odynophagia
Eosinophilic Esophagitis,Severe retching
Severe allergic colitis/malabsorption
Susp eosinophilic colitis,chronic diarrhea,
Laryngomalacia,Gas/Bloat Syndrome,
Visceral Hyperalgesia,GI Dysmotility,
Chronic infection(ear/sinus/lung)
Adenoid/tonsillar hypertrophy
Gait abnormality/bowlegs,widened growth plates
Susp Vagus Nerve Damage
Surgeries, Nissen fundo,hernia repair/
reconstruction,esophageal dilation,gtube,
ear tubes,adenoidectomy
Bronchs w/ BAL's,lung biopsy
Upcoming scope/colonoscopy
Manometry testing in Oct.
Meds: Nexium,Zantac,Baclofen, Neurontin,
Zofran,Pulmicort/Splenda,PrednisonePRN,
NPO tubefed continuous elecare 24 hours/day
Article on EGID Katiesmommy/bgirl/engin117 if interested
Eosinophilic gastroenteropathies are gastrointestinal (GI) diseases (enteropathies) in which one or more layers of the GI tract (most commonly the stomach and small intestine) are selectively infiltrated with a type of white blood cell called eosinophils, as part of an allergic response. Description Eosinophilic gastroenteropathies are characterized by the accumulation of an abnormally large number of eosinophils (eosinophilic infiltration) in one or more specific places anywhere in the digestive system and associated lymph nodes resulting in nausea, difficulty swallowing, abdominal pain, vomiting and diarrhea, excessive loss of proteins in the GI tract, and failure to thrive. All gastroenteropathies are characterized by the presence of abnormal GI symptoms, eosinophilic infiltration in one or more areas of the GI tract, and the absence of an identified cause for the formation of an abnormally large number of eosinophils in the blood (eosinophilia). Some patients also suffer loss of protein from the body that often results in low blood levels of albumin and total protein (protein-losing enteropathy) due to increased GI tract permeability. As the GI tract wall becomes infiltrated with large numbers of eosinophils, its normal architecture is disrupted, and so is its function. Eosinophils are immune system white blood cells that destroy parasitic organisms and play a major role in allergic reactions. For this reason, the gastroenteropathies are often considered as food-related gastrointestinal allergy syndromes. Eosinophilic gastroenteropathies have a specific name corresponding to the area of the digestive system where the highest numbers of eosinophils are found. They include the following: eosinophilic gastroenteritis (EG), in which eosinophilic infiltration occurs in one or more layers of the stomach and/or small intestine eosinophilic esophagitis (EE), in which eosinophilic infiltration is confined to the muscular tube that carries food from the throat to the stomach (esophagus) eosinophilic colitis (EC), in which the infiltration is confined to the large intestine (colon) eosinophilic duodenitis (ED), in which the infiltration is confined to the small intestine Eosinophilic gastroenteritis (EG) is the best characterized gastroenteropathy. It is classified according to the layer of the GI tract involved, and mixed forms also occur. The walls of the GI tract have four layers of tissue, called mucosa, submucosa, muscularis externa, and serosa. The innermost layer is the mucosa, a membrane that forms a continuous lining of the GI tract from the mouth to the anus. In the large bowel, this tissue contains cells that produce mucus to lubricate and protect the smooth inner surface of the bowel wall. Connective tissue and muscle separate the muscosa from the second layer, the submucosa, which contains blood vessels, lymph vessels, nerves, and glands. Next to the submucosa is the muscularis externa, consisting of two layers of muscle fibers, one that runs lengthwise and one that encircles the bowel. The fourth layer, the serosa, is a thin membrane that produces fluid to lubricate the outer surface of the bowel so that it can slide against adjacent organs. The different types of EG are: Pattern I eosinophilic gastroenteritis: Children affected with Pattern I EG have extensive infiltration of eosinophils in the area below the submucosa and muscularis layers. It is more commonly seen in the stomach (gastric antrum) but may also affect the small intestine or colon. Patients typically have intestinal obstruction. Cramping and abdominal pain associated with nausea and vomiting occur frequently. Food allergy and past history of allergy are less common in these patients than in patients with Pattern II EG. Pattern II eosinophilic gastroenteritis: In this the most prevalent form of EG, extensive infiltration of eosinophils occurs in the mucosal and submucosal layers. These patients have colicky abdominal pain, nausea, vomiting, diarrhea, and weight loss. Infants with Pattern II EG also commonly have a history of allergy. The condition may also be associated with protein-losing enteropathy, low levels of iron in the blood serum or in the bone marrow (iron-deficiency anemia), or impaired absorption of nutrients by the intestines (malabsorption). Growth retardation, delayed puberty, or abnormal menstruations has also been reported in children and adolescents with Pattern II EG. Pattern III eosinophilic gastroenteritis: This least common form of eosinophilic gastroenteropathy involves the serosal layer and the entire GI wall is usually affected. Its inflammation leads to an accumulation of fluid in the abdomen (ascites). This fluid contains many eosinophils and can infiltrate the membrane of the lungs (pleural effusion). A history of allergy also appears to be common in this group. Symptoms may include chest pain, fever, shortness of breath, and limited motion of the chest wall. Eosinophilic esophagitis (EE) is characterized by the abnormal accumulation of eosinophils localized in the esophagus. In EE, high levels of eosinophils are detected in the esophagus but not in any other parts of the digestive tract. The presence of the eosinophils in the esophagus causes inflammation of its walls, which makes digestion extremely painful. Unlike that of normal children, the esophagus of an individual with EE does not have a smooth, uniform pink surface but displays lines (furrowing) and white patches. Children with EE have classic signs of gastroesophageal reflux (abdominal pain, difficulty swallowing, and vomiting) but fail to respond to antireflux medications. The danger of failing to diagnose this disorder is that children may be referred for unnecessary surgery because of their reflux symptoms. Eosinophilic colitis (EC) is characterized by eosinophilic infiltration localized only in the large bowel, resulting in fever, diarrhea, bloody stools, constipation, obstruction/strictures, acute abdominal pain, and tenderness often localized in the right lower abdomen. EC often follows the onset of EG. Eosinophilic duodenitis (ED) is characterized by eosinophilic inflammation of the small bowel that results in the production of leukotrienes, substances that participate in defense reactions and contribute to hypersensitivity and inflammation. Malabsorption of nutrients always results along with severe cramping, bowel obstruction, and intestinal bleeding with passage of bloody stools. Causes and symptoms The eosinophil is a component of the immune system and is particularly involved with defense against parasites, but as of 2004 no parasite had been found responsible for any of the eosinophilic gastroenteropathies. The cause or mechanism of eosinophilic infiltration is also unknown, although some scientists suspect that the condition, first identified in Europe in the mid 1940s, is genetic, as it seems that in about 16 percent of known cases, an immediate family member is also diagnosed with an eosinophilic GI disorder. Various factors have been shown to trigger eosinophilic infiltration of the GI tract, and it has been shown that this, in turn, causes tissue damage by loss of cell granules (degranulation) and the untimely release of small proteins specialized in cell-to-cell communication (cytokines) that directly damage the GI tract wall. Examples of factors that are believed to have an incriminating role in triggering a flare-up include foods that trigger an allergic reaction (allergens) and immunodeficiency disorders caused by very low levels of immunoglobulins that result in an increased susceptibility to infection. Honey intolerance and bee pollen administration have also been suggested as a causative agent for EG. Researchers have confirmed a familial pattern to EE, which suggests either a genetic predisposition or a relationship to an unknown environmental exposure. Gastroenteropathy symptoms vary depending on where the eosinophils are found and in what layer of the digestive system their numbers are highest. Symptoms therefore tend to be highly specific to each individual case. They may only appear when certain foods are ingested, or only during certain seasons of the year, or every few weeks, or in severe cases, every time any food is eaten. Infants with eosinophilic gastroenteropathies usually have acute reactions after food intake (within minutes to in one to two hours) that generally include nausea, vomiting and severe abdominal pain, later followed by diarrhea. These symptoms may occur alone or as part of a shock reaction. Symptoms vary depending on the type of gastroenteropathy (EG, EE, EC, or ED) and on the precise location of eosinophilic infiltration within the digestive system, as well as which layer or layers of the digestive system wall is infiltrated with eosinophils. Symptoms include, but are not limited to, the following: abdominal pain (EG, EE, ED) anorexia (EG, EE) asthma (EE) bloating (EG, ED, EC) cramps (EG, EC, ED) feeling full before finishing a meal (early satiety) (EG) milk/formula regurgitation (EG, EE) nausea, vomiting (EG, EE, EC, ED) weight loss (EG, EE, EC, ED) diarrhea (EG, EC, ED) presence of fluid (edema) in ankles (EG, EE) choking (EE) difficulty swallowing (dysphagia) (EG, EE) strictures (EE, EC) passage of dark stools (melena) (EG, EC, ED) constipation (EC, ED) bowel obstruction (EC, ED) intestinal bleeding (EC, ED) Diagnosis Eosinophilic gastroenteropathies are diseases that can be easily misdiagnosed. EE has long been misdiagnosed as gastroesophageal reflux, another digestive disease in which partially digested food from the stomach regurgitates and backs up (reflux). However, EE differs from esophageal reflux in the large numbers of eosinophils that are present in the GI tract. Diagnosis for eosinophilic gastroenteropathies is therefore only established on microscopic analysis of a tissue specimen (biopsy) revealing eosinophilic infiltration. Additionally, diagnosis is based on the following: Complete blood count (CBC): CBC reveals the presence of blood eosinophilia, found in 20 to 80 percent of cases. CBC also appears to differentiate between different types of eosinophilic gastroenteropathies, since they have different total eosinophil counts. Mean corpuscular volume test: This test can determine the presence of iron-deficiency anemia and serum albumin levels that vary according to disorder type. Fecal protein loss test: This test is used to identify the inability to digest and absorb proteins in the GI tract. Imaging tests: Ultrasound and CT scan may show thickened intestinal walls and ascitic fluid in patients with Pattern III EG, as well as the degree of involvement of the different layers. Barium studies: In this test, the patient ingests a barium sulfate solution that makes for contrast on x rays. Barium studies can reveal mucosal edema and thickening of the small intestinal wall in EC and ED. Exploratory abdominal surgery (laparotomy): In some cases, laparotomy may be indicated, especially in patients with Pattern III EG. Treatment Treatment of eosinophilic gastroenteropathies is mainly symptomatic and supportive. Surgery may be necessary in severe EC cases in which there is obstruction of the intestines. There is no known cure for eosinophilic gastroenteropathies, so medications are used to relieve symptoms and prevent full-blown attacks (or flare-ups). The only known medication to successfully stop eosinophilic inflammation is the corticosteroid drug, prednisone. Oral glucocorticosteroids are usually prescribed for those with EC or ED obstructive symptoms. Children with Pattern II EG may benefit from anti-inflammatory medications (for example, oral glucocorticoids or oral cromolyn) and specialized diet therapy, particularly in the case of food intolerance or allergy. Fluticasone propionate (Flonase, Flovent) is reported to be helpful in most cases of EG, if the medicine is swallowed so that it comes directly in contact with the esophageal tissues that are infiltrated by eosinophils. There is also reported success with use of a drug (Montelukast) that stops the production of the inflammatory leukotrienes associated with EC. Elemental formulas are also very effective. Cromolyn sodium (Gastrocrom) has been used with some success but does not work in all cases.
Sep 30, 2008
jessicalynn
Brent 2 years old,
Birthweight 12 lbs 3.3 oz!
Very severe GERD,LPR,FTT
Severe esophagitis/scarring
Paraesophageal Hiatal Hernia,
Esophageal Dysmotility,
Food impaction,Aspiration
ALTE,Dysphagia,Odynophagia
Eosinophilic Esophagitis,Severe retching
Severe allergic colitis/malabsorption
Susp eosinophilic colitis,chronic diarrhea,
Laryngomalacia,Gas/Bloat Syndrome,
Visceral Hyperalgesia,GI Dysmotility,
Chronic infection(ear/sinus/lung)
Adenoid/tonsillar hypertrophy
Gait abnormality/bowlegs,widened growth plates
Susp Vagus Nerve Damage
Surgeries, Nissen fundo,hernia repair/
reconstruction,esophageal dilation,gtube,
ear tubes,adenoidectomy
Bronchs w/ BAL's,lung biopsy
Upcoming scope/colonoscopy
Manometry testing in Oct.
Meds: Nexium,Zantac,Baclofen, Neurontin,
Zofran,Pulmicort/Splenda,PrednisonePRN,
NPO tubefed continuous elecare 24 hours/day
(Wanted to bring this out, this list is of symptoms from the article correllating to the part of the GI tract that is affected with Eosinophilic Disorder.)(EG eos gastrenteritis,EE eos esophagitis,EC Eos Colitis,ED Eos Duodenitis)) Symptoms include, but are not limited to, the following: abdominal pain (EG, EE, ED) anorexia (EG, EE) asthma (EE) bloating (EG, ED, EC) cramps (EG, EC, ED) feeling full before finishing a meal (early satiety) (EG) milk/formula regurgitation (EG, EE) nausea, vomiting (EG, EE, EC, ED) weight loss (EG, EE, EC, ED) diarrhea (EG, EC, ED) presence of fluid (edema) in ankles (EG, EE) choking (EE) difficulty swallowing (dysphagia) (EG, EE) strictures (EE, EC) passage of dark stools (melena) (EG, EC, ED) constipation (EC, ED) bowel obstruction (EC, ED) intestinal bleeding (EC, ED
Sep 30, 2008
mom2adriane&morgan
Adriane Reese 05/16/07; seemingly healthy when born; diagnosed with MSPI, severe Reflux, Apnea, Ashtma, Epilepsy, and severe food allergies(rice, corn, milk, soy, eggs, oats, wheat, beef, chicken, squash, pumpkin, avocado, etc.);On apnea monitor, seems to be tolerating RCF w/carbohydrate mixed in; on Zyrtec, Xopenex, Prevacid
Thanks for the info. This is probably the most informative article that I have seen on this subject. We go back to the GI doc next week. I'm hoping they can shed some light on the issues with the diarhea that she has everytime she eats something.

-Amanda

Sep 30, 2008
b-girl
Mom to Jasmine aka: Jazz 01/24/2007
Dx with silent reflux at 8 months
FPIES, DGE, MSPI. Recently diagnosed with EC (Eosin. colitis and now Primary immune deficiency disease.
Also mom to Nathan. born Jan.20th, 2009, MPI . so far dx with reflux and has an extremely sensitibe GI system. Also dx with primary immune deficiency disease.
Great article, thanks very much!!! This type of info is hard to come by......
Sep 30, 2008
katiesmommy
Tracey, mom to Katie. Diagnosed with reflux at 3 weeks and put on Zantac. At 8 months old she was removed from Zantac as it was giving her migraines, currently on Prevacid. Switched to Elecare since she is not gaining weight; trialing solids after being off for a month. Geneticist said reason she isn't gaining weight is she is stubborn. Upcoming appts.: Neurologist for developmental delay and EGD scheduled for September. She is one funny baby!
Thanks Jessica! The anexoria caught my eye since Katie has been labeled that by the geneticist and she cannot take more than a few ounces of formula at once. I n ever thought that her having more solid poo could be a symptom of something not quite right; I always attributed it to solids. When she was off of solids for a month in the hopes of letting her heal she still had solid poo. It did make us think at the time......
Sep 30, 2008
engin117
My name is being used fraudently to ill represent me. Please be cautious of any information you receive with my name. including engi.nowaira.net, engi@nowaira.net, Engi@nowaira.us, anything from anyone claiming to be Engi Nowaira online. Otherwise, I will be representing myself in person so that everyone will have opportunity to identify me in person.
My previous drivers license was also stolen. The new one has extra security features on it.
Where is the info from?
Jessica,

Very much informative. Certainly more than I have found at this time. Can u tell us the source that we have a way to stay updated. I am very grateful for all the help.

Amanda,

Meggy used to have problems with constipation. Now we are also having problems with diarrhea. It seems to be no matter what she eats. Is Adriane Reese always bloated as well. Meggy's belly looks like a balloon often.

Tracey,

Meggy's Neuro also said she was having migraines, but I had never attributed it to the Zantac till you said that. Our GI said it makes no sense that we tell her Meggy screams louder and harder when she gets Zantac. She doesn't stop screaming till she is so tired she falls asleep.

Her docs. kept telling us it wasn't possible, but now that you say that it makes sense.

Sep 30, 2008
jessicalynn
Brent 2 years old,
Birthweight 12 lbs 3.3 oz!
Very severe GERD,LPR,FTT
Severe esophagitis/scarring
Paraesophageal Hiatal Hernia,
Esophageal Dysmotility,
Food impaction,Aspiration
ALTE,Dysphagia,Odynophagia
Eosinophilic Esophagitis,Severe retching
Severe allergic colitis/malabsorption
Susp eosinophilic colitis,chronic diarrhea,
Laryngomalacia,Gas/Bloat Syndrome,
Visceral Hyperalgesia,GI Dysmotility,
Chronic infection(ear/sinus/lung)
Adenoid/tonsillar hypertrophy
Gait abnormality/bowlegs,widened growth plates
Susp Vagus Nerve Damage
Surgeries, Nissen fundo,hernia repair/
reconstruction,esophageal dilation,gtube,
ear tubes,adenoidectomy
Bronchs w/ BAL's,lung biopsy
Upcoming scope/colonoscopy
Manometry testing in Oct.
Meds: Nexium,Zantac,Baclofen, Neurontin,
Zofran,Pulmicort/Splenda,PrednisonePRN,
NPO tubefed continuous elecare 24 hours/day
I know, it's hard to find good info. Heres some websites: https://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/LiacourasArticle.pdf....http://www.healthofchildren.com/E-F/Eosinophilic-Gastroenteropathies.html.....http://pediatrics.aappublications.org/cgi/content/full/111/6/S2/1609.....http://www.allergysa.org/journals/2008/june/gastrointestinal%20syndromes%20in.pdf....http://www.apfed.org/.....http://www.curedfoundation.org/....http://www.parent-2-parent.com/forum/forumdisplay.php?f=119......http://kidswithfoodallergies.org/eve/forums.....http://www.cincinnatichildrens.org/svc/alpha/e/eosinophilic/default.htm There are a lot of resources available at the Food Allergy Network Support Forums. To read the Eosinphilic Forum you must upgrade to Family Member which is 25 dollars a year, or you can request sponsorship, where they let you do if for free if you apply and are approved because of the condition of your child/ finances. That is what I did, just requested it because Brent has been so sick and we are financially strapped, I think it was the next day I got an email saying my sponsorship was approved. I get a lot of info from there.
Sep 30, 2008
b-girl
Mom to Jasmine aka: Jazz 01/24/2007
Dx with silent reflux at 8 months
FPIES, DGE, MSPI. Recently diagnosed with EC (Eosin. colitis and now Primary immune deficiency disease.
Also mom to Nathan. born Jan.20th, 2009, MPI . so far dx with reflux and has an extremely sensitibe GI system. Also dx with primary immune deficiency disease.
Jasmine's story is textbook from what I've read as well. She had problems with constipation/dirrhea- no matter what she ate as well, no appetite, delayed gastric emptying, so bloated she looks pregnant, gets facial edema every week or so and on and on...... It's sad to watch her suffer so..... Anyways, I am so happy that you mentioned that the food allery site accepts members for free. I am going to apply as well because I really want to get as much info as I can about this. Thanks again.....
Oct 01, 2008
blueleopard
Pictured: G'mom w/3 kids. I'm mom to 1 angel Melissa (dec'd 11/92 - hypoplastic left-heart syn.)
2 healthy daughters (knock wood) Cory (16), Kim (11) & Eric (4) diagnosed with e.e. (scoped 8/08), GERD & severe food/seasonal allergies, asthma. Cried non-stop first 17 mths. of life Found out he is allergic to cow's milk, soy, eggs, and peanuts. Takes Prevacid, Neocate One Plus & Flovent.
Wow - that was a lot to type out. I really do appreciate the info. as Eric was diagnosed with e.e. & may have issues further down (constipation/pain), which will be uncovered with a sigmoid. later down the road. Ellen
Check with your
doctor first!